National Registry of EMTs

National Registered Paramedics

The Paramedic is an allied health professional whose primary focus is to provide advanced emergency medical care for critical and emergent patients who access the emergency medical system. This individual possesses the complex knowledge and skills necessary to provide patient care and transportation. Paramedics function as part of a comprehensive EMS response, under medical oversight. Paramedics perform interventions with the basic and advanced equipment typically found on an ambulance. The Paramedic is a link from the scene into the health care system.
[From the: National EMS Scope of Practice Model]


How to become a Nationally Certified Paramedic?

Individuals applying for National Paramedic certification must meet the following requirements:
  1. 18 years of age or older.
  2. Possess current National Certification at the EMT level or a current state license at the EMT level or higher.
  3. Since January 1, 2013, Paramedic applicants must have successfully completed state-approved and CAAHEP-accredited Paramedic (NRP) program (or a program that has a current "Letter of Review"). Paramedic applicants who began their education program prior to January 1, 2013 must have completed a state-approved Paramedic course that meets or exceeds the National EMS Education Standards for Paramedic. This course must have been completed within the past two years and the course Program Director must verify the candidate's successful completion of the course through the NREMT website.
  4. Beginning August 1, 2016, all students who begin a Paramedic education program are required to complete a psychomotor competency portfolio.
    • Program Directors must verify that candidates have met the requirements of the portfolio through the NREMT website
    • If the initial Paramedic (NRP) educational program was completed more than two years ago and the candidate is currently state licensed at the Paramedic (NRP) level, candidates are required to submit documentation verifying completion of a state-approved Paramedic (NRP) refresher course or 48 hours of equivalent continuing education covering the mandatory and flexible core content topics specified within the past two years.
    • If a candidate's Paramedic state license has lapsed, or an individual's NRP has lapsed for more than two years, Paramedics must use the re-entry process.
    • If a candidate has never held a state license as a Paramedic or NRP and it has been more than two years from the completion of the candidate's Paramedic course, they must complete an entire state-approved and CAAHEP-accredited Paramedic program prior to applying for National Certification.
  5. Have a current CPR-BLS for Healthcare Providers or equivalent credential.
  6. Successful completion of the NREMT Paramedic Psychomotor Exam.
  7. Successful completion of the Paramedic Cognitive Exam

Application Process

  • Create an account/login profile on this website.
  • Submit a NREMT application and answer all questions truthfully.
  • The NREMT may deny certification or take other appropriate actions in regards to applicants for certification or recertification when a criminal conviction has occurred.
  • Pay the application fee of $110 (US funds). The application fee is non-transferable and non-refundable. This fee is charged for each attempt of the cognitive examination.
  • Candidates will receive an electronic Authorization to Test (ATT) once you are eligible for the exam. The electronic ATT contains scheduling instructions and important details concerning proper identification required at testing centers. You can find the ATT in the 'Check Application Status' page.

Certification Process

National Advanced Emergency Medical Technician certification requires successful completion of both a cognitive (knowledge) and psychomotor (skills) exam. Passed portions of the exam (both cognitive and psychomotor) remain valid for up to a twelve (12) month period, provided all other requirements for NREMR certification are met.

The Cognitive Exam Apply For A Cognitive Exam

The NREMT Paramedic (NRP) cognitive exam is a computer adaptive test (CAT). The number of items a candidate can expect on the Paramedic (NRP) exam will range from 80 to 150. The maximum amount of time given to complete the exam is 2 hours and 30 minutes.

The exam will cover the entire spectrum of EMS care including: Airway, Respiration & Ventilation; Cardiology & Resuscitation; Trauma; Medical; Obstetrics/Gynecology; EMS Operations. Items related to patient care are focused on adult and geriatric patients (85%) and pediatric patients (15%). In order to pass the exam, candidates must meet a standard level of competency. The passing standard is defined by the ability to provide safe and effective entry level emergency medical care.

We strongly encourage candidates to review the following information:

Paramedic Cognitive Exam Test Plan

Based on the most recent practice analysis, the NREMT Board approves a cognitive exam test plan. A test plan is a blue-print that tells the computer testing software how to build a candidate's exam. The table below indicates what percent of the test will focus on each topic area.

Content Area Percent of Exam Adult / Pediatric Mix
Airway, Respiration & Ventilation 18%-22% 85% Adult; 15% Pediatric
Cardiology & Resuscitation 22%-26% 85% Adult; 15% Pediatric
Trauma 13%-17% 85% Adult; 15% Pediatric
Medical; Obstetrics & Gyn 25%-29% 85% Adult; 15% Pediatric
EMS Ops 10%-14% N/A

Cognitive Exam Retest Information

If a candidate is not successful in passing the cognitive exam, the NREMT will provide a candidate feedback on their performance. Candidates may apply to retest 15 days after the last examination.

Candidates are given a total of six opportunities to pass the Paramedic cognitive examination, provided all other requirements for National EMS Certification are met. After three attempts, candidates must submit official documentation verifying completion of 48 hours of remedial training.* After remedial training is complete, the candidate is given three additional attempts to pass the EMT cognitive exam, provided all other requirements for National Certification are met. Candidates who fail to pass after a total of six attempts are required to repeat the entire Advanced Emergency Medical Technician (EMT) course.
Note: Some states require the traditional refresher course and will not accept continuing education hours. Please refer to your state's particular requirements. A maximum number of 10 hours can be applied from Distributive Education towards this section and must be state or CAPCE approved.

The Psychomotor Exam (Traditional) Find A Psychomotor Exam

The Paramedic psychomotor examination consists of twelve skills presented in a scenario-type format. All skills have been developed in accordance with the National EMS Education Standards and Instructional Guidelines (EMT and Paramedic), the American Heart Association Guidelines for CPR and ECC, and the U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Trauma Triage Protocol.

  • Paramedic (NRP) candidates may take the psychomotor evaluation (practical exam) following completion of the didactic and laboratory portions of an approved program if permitted by the program director and the State EMS Licensing Agency.
  • Candidates are permitted to bring their own equipment for the examination, provided it is approved for testing by the NREMT Representative in attendance at the examination.

The psychomotor examination process is a formal verification of the candidate's "hands-on" abilities and knowledge. Apart from Pass or Fail, candidates are not provided with specific feedback regarding their exam performance.

Paramedics are required to demonstrate proficiency on the following skills:

Patient Assessment-Trauma

Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:

  • Scene Size-Up
  • Primary Survey/Resuscitation
  • History Taking
  • Secondary Assessment

Ventilatory Management

Candidates are evaluated over the following two (2) ventilatory management scenarios:

  • Apneic Adult

Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen, followed by the placement of a supraglottic airway device (King®,Combitube®, etc.).

  • Supraglottic Airway Device

Given a scenario of having just found an apneic patient with a palpable carotid pulse, candidates must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. Candidates will then complete the adult presentation by placing an endotracheal tube (ET). Additionally, candidates will be given a scenario of having just found an apneic patient with a palpable carotid pulse and must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. Next, they must place the Combitube®, King LT®, or PTL® in the adult patient.

Cardiac Management Skills

The candidate is evaluated on their ability to manage cardiac arrhythmias and interpret ECGs. This will be verified in two portions:

You will be evaluated on your ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario. The presentation of the portion will be similar to a "megacode."

Given four (4) prepared ECG tracings with associated patient information, you must verbalize the interpretation of each rhythm and voice all associated treatments.

IV and Medication Skills

Intravenous Therapy: Candidates are required to establish a patent IV in a manikin arm in accordance with a given scenario.
Intravenous Bolus Medications: After establishing a patient IV line, candidates must administer an IV bolus of medication in accordance with a given scenario.

Oral Stations

Oral Station

You will be evaluated on your ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases: Oral A & Oral B

In each case, you will be evaluated in the following categories:

  • Scene Management
  • Patient Assessment
  • Patient Management
  • Interpersonal Relations
  • Integration (verbal report, field impression, and transport decision)

Pediatric Skills

Candidates are evaluation on the following pediatric skills:

Candidates are required to establish an intraosseous line in a pediatric IO manikin. (Manual insertion with a Jamshidi® needle or battery-powered drill-type devices are permitted.)

Given a scenario of having just found an apneic infant with a palpable brachial pulse, you must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen. You will then be required to place an endotracheal tube (ET).

Random EMT Skills

Each candidate will be evaluated on one of the following randomly selected EMT skills.


Paramedic Psychomotor Exam (Traditional) Retest

Paramedic candidates are allowed three (3) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all twelve (12) skills and two retesting opportunities if so entitled).

Candidates who fail a full attempt or any portion of a second retest must submit official documentation of remedial training over all skills before starting the next full attempt of the psychomotor examination and re-examining over all twelve (12) skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by the Paramedic Training Program Director or Physician Director of training/operations that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.

Should a candidate fail the third full and final attempt of the psychomotor examination, the candidate must complete a new, state-approved and CAAHEP-accredited Paramedic Education Program.


The Psychomotor Exam (Phase 1 Scenario Based) Find A Psychomotor Exam

Beginning January 1, 2017, the NREMT will implement the new scenario-based psychomotor exam. In the new test model, Paramedic candidates will be tested on a total of six skills. Five skills from the traditional NRP Psychomotor Examination (Patient Assessment – Trauma, Dynamic Cardiology, Static Cardiology, Oral Station Case A, Oral Station Case B) will be tested, with the addition of an Integrated Out-Of-Hospital Scenario.

Patient Assessment-Trauma

Candidates are required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:

  • Scene Size-Up
  • Primary Survey/Resuscitation
  • History Taking
  • Secondary Assessment

Cardiac Management Skills

The candidate is evaluated on their ability to manage cardiac arrhythmias and interpret ECGs. This will be verified in two portions:

You will be evaluated on your ability to manage a cardiac arrest situation, including actual delivery of electrical therapy and "voicing" all interpretations and treatments given a scenario. The presentation of the portion will be similar to a "megacode."

Given four (4) prepared ECG tracings with associated patient information, you must verbalize the interpretation of each rhythm and voice all associated treatments.

Oral Station - Scenario A & B

Oral Station

You will be evaluated on your ability to verbally manage all aspects of an out-of-hospital call given two (2) separate cases: Oral A & Oral B

In each case, you will be evaluated in the following categories:

  • Scene Management
  • Patient Assessment
  • Patient Management
  • Interpersonal Relations
  • Integration (verbal report, field impression, and transport decision)

Integrated Out-Of-Hospital Scenario

The Integrated Out-Of-Hospital Scenario (IOOH) will reflect either a pediatric, geriatric or adult patient. The candidate will be provided with a professional paramedic partner and evaluated on their ability to manage a call, lead a team, effectively communicate, and maintain professionalism throughout the simulated patient encounter.

Paramedic Phase 1 Psychomotor Exam Retest

Paramedic candidates are allowed two (2) full attempts to pass the psychomotor examination (one "full attempt" is defined as completing all six (6) skills and two retesting opportunities if so entitled).

Candidates who fail a full attempt or any portion of a second retest must submit official documentation of remedial training over all skills before starting the next full attempt of the psychomotor examination and re-examining over all six (6) skills, provided all other requirements for National Certification are fulfilled. This official documentation must be signed by the Paramedic Training Program Director or Physician Director of training/operations that verifies remedial training over all skills has occurred since the last unsuccessful attempt and the candidate has demonstrated competence in all skills.

Should a candidate fail the second full and final attempt of the psychomotor examination, the candidate must complete a new, state-approved and CAAHEP-accredited Paramedic Education Program.

Related Videos

Detailed Overview of the Integrated Out of Hospital Scenario (IOOH)

A Critical Fail Example: Integrated Out of Hospital Scenario

How an IOOH Scenario is Scored


Paramedic Education Program Information

Program Accreditation

Find An Accreditated Paramedic Program

Since January 1, 2013 all initial Paramedic applicants seeking NREMT's National EMS Certification at the Paramedic level must have successfully completed education from an accredited program or one that is seeking accreditation sponsored by the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

Paramedic Portifolio

Paramedic Portfolio Information

The NREMT developed a portfolio of vital skills that each paramedic student must master to qualify for the NRP Certification examination. The program tracks each student's portfolio throughout the formative and summative phases of education in the laboratory, clinical, and field internship settings. The completed portfolio provides a mass of evidence that documents a candidate’s acquisition of psychomotor competency in the skills we currently evaluate on the 12-skill NRP Psychomotor Examination. All students that begin their paramedic program on or after August 1, 2016 are required to complete a portfolio that becomes a part of their permanent educational file and is a prerequisite to seeking NRP Certification.

Expiration Dates

Initial expiration dates are determined by the date the candidate successfully completes the entire national certification process (cognitive and psychomotor exams). EMT, AEMT, and Paramedic candidates completing the national certification process between the January 1 and June 30 will receive an expiration date of March 31 two years in the future. Individuals successfully completing the national certification process between July 1 and December 31 will receive an expiration date of March 31 three years in the future.

Expiration Dates

Initial Certification

Initial Cycle

If you successfully completed the national certification process between: Your initial certification date will be March 31
January 01-June 30 2 years in the future
July 1-December 31 3 years in the future
How do I recertify?

Detailed information about the recertification process for Paramedics is on the Paramedic Recertification Page.

Lapsed Paramedic Certification

Lapsed 0-24 Months

If the Paramedic did not meet all recertification requirements by the expiration date, the National EMS certification is considered to be lapsed. If the certification lapsed less than two years, or you are currently state licensed as a Paramedic, you can regain National EMS Certification by completing the cognitive and psychomotor examinations.

To obtain an authorization to test, lapsed Paramedics must demonstrate proof of education requirements. The following methods are acceptable:

  • Complete a Traditional State Approved Paramedic Refresher
  • State approved continuing education equal to the Paramedic Refresher
  • If the Paramedic was licensed in a NCCP state, completion of the National Component meets the requirement

Lapsed More Than 2 Years

Entry and/or re-entry into the NREMT may be granted to a previously state licensed or Nationally Certified Paramedic (NRP) provided you:

  1. Officially document completion of a DOT Paramedic (NRP) Training Program after January 1, 1977. *
  2. Show satisfactory evidence to the NREMT of prior state licensure at the Paramedic (NRP) level.
  3. Have current ACLS provider or instructor credential.
  4. Completed either PHTLS or ITLS as a provider or instructor within the past two (2) years.
  5. Have completed a state-approved Paramedic (NRP) refresher; or 48 hours of equivalent continuing education covering the mandatory and flexible core content topics specified; or the NCCP National Component module, within the past two years.
  6. Have a letter of approval from the state EMS office in the state where you work or are to work. The letter should show the state's support for you to obtain state licensure through this process.
  7. Successfully complete the NREMT Paramedic (NRP) cognitive and psychomotor examinations.

* All candidates for NREMT’s National EMS Certification at the Paramedic level whose Paramedic program began on or after January 1, 2013 must have successfully completed Paramedic education from an accredited program sponsored by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or one who held a valid Letter of Review (LOR) issued by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

Frequently Asked Questions

Responsibilities of Certified Paramedics

Nationally Certified Paramedics must notify the NREMT within 30 days regarding the following matters:
  • change in mailing address (the best way to update a mailing address is by editing the user profile page)
  • any criminal conviction.
  • disciplinary action taken by any state has resulted in suspension, revocation, or expiration of state registration/licensure; termination of right to practice; voluntary surrender of state registration/licensure while under investigation.
The NREMT considers the individual to be solely responsible for their certification.

Americans with Disabilities Act

The NREMT complies with the Americans with Disabilities Act (ADA) of 1990 and offers reasonable accommodations for individuals with disabilities. Pearson VUE test centers are also ADA compliant. Complete information about the NREMT Accommodations Disability Policy can be found here.

Cognitive Exam
Exam Type: Computer Adaptive
Questions: 80-150
Time Limit: 2 hours, 30 min
Paramedic Info
Cognitive Exam Fee: $110
(Per exam attempt)
2017 Cognitive Exam Fee: $125
(Per exam attempt)
Renewal Fee: $20
Late Fee: $50+Renewal Fee
Age: 18 Years Old
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